Back pain can be caused by compression. Gravity is constantly acting on the body and over time slowly forces the spine closer together. This is one of the reasons why elderly people appear to shrink with age—where their spines are actually compressing. Additionally, back pain is common amongst office workers that spend a majority of time at their desk/chair sitting. Improper posture and slouching coupled with hours of inactivity can result in chronic back pain.
The lumbar region (or lower back region) is made up of five vertebrae (L1-L5). In between these vertebrae lie fibrocartilage discs (intervertebral discs), which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the spinal cord. Nerves stem from the spinal cord extend through forming within the vertebrae, providing muscles with sensations and motor-associated messages. Stability of the spine is provided through ligaments and muscles of the back, lower back and abdomen. Small joints which prevent, as well as direct, motion of the spine are called facet joints (zygapophysial joints).
Causes of lower back pain can be varied. In some cases, it can be due to a sprain or strain in the muscles and soft tissues of the back. Over use of the muscles of the back can lead to an injured or torn ligament in the back which in turn leads to pain. An injury can also occur to one of the intervertebral discs (disc tear, disc herniation). Due to aging, discs begin to reduce in size, resulting in vertebrae and facet joints rubbing against one another. Ligament and joint functionality also diminishes as aging progresses, leading to spondylolisthesis, which causes the vertebrae to move more than they should. Pain is also generated through lumbar spinal stenosis, sciatica and scoliosis. At the lowest end of the spine, pain can be experienced at the tailbone (also called coccyx pain or coccydynia). Pain can also result at the sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture (such as from osteoporosis).
Spinal manipulation is a therapeutic intervention that has roots in traditional medicine and has been used by various cultures, apparently for thousands of years. Hippocrates, the “father of medicine” used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of osteopathic medicine and chiropractic. Spinal manipulative therapy gained recognition by mainstream medicine during the 1980s.
It is not known if chiropractic care improves clinical outcomes in those with lower back pain more or less than other possible treatments. A 2004 Cochrane review found that spinal manipulation (SM) was no more or less effective than other commonly used therapies such as pain medication, physical therapy, exercises, back school or the care given by a general practitioner. A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain relief and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. In 2007, the American College of Physicians and the American Pain Society jointly recommended that clinicians consider spinal manipulation for patients who do not improve with aforementioned options. Reviews published in 2008 and 2006 suggested that SM for lower back pain was equally effective as other commonly used interventions.
Over a lifetime, 80% of people have lower back pain, with 26% of American adults reporting pain of at least one day in duration every three months. 41% of adults aged between 26 and 44 years reported having back pain in the previous 6 months. In the United States, the costs of low back pain range between $38 and $50 billion a year and there are 300,000 operations annually. Along with neck operations, back operations are the 3rd most common form of surgery in the United States.